Asma nuwere konsepte - PowerPoint PPT Presentation

1 / 40
About This Presentation
Title:

Asma nuwere konsepte

Description:

Sx: Hoes en/of sputum en/of brongospasma. Keer om spontaan of met medikasie ... Spirometrie: Fev 1 minder as 80% van voorspelde waarde. FEV1/VK minder as 65 ... – PowerPoint PPT presentation

Number of Views:396
Avg rating:3.0/5.0
Slides: 41
Provided by: freekb
Category:
Tags: asma | konsepte | nuwere | sputum

less

Transcript and Presenter's Notes

Title: Asma nuwere konsepte


1
Asma - nuwere konsepte
  • Dr FCJ Bester
  • Tel 051 522 1907
  • Sell 082 554 2799

2
Lesingskedule
  • Definisie van Asma
  • Patologie van Asma
  • Diagnose van Asma
  • Hantering van Asma
  • NAEP protokol

3
Wat is Asma ?
  • Chroniese inflammatoriese toestand
  • Episodiese irriteerbaarheid
  • Sx Hoes en/of sputum en/of brongospasma
  • Keer om spontaan of met medikasie

4
Kenmerke van asma in die afwesigheid van
  • Linker ventrikulêre versaking
  • Infektiewe longsiekte
  • Degeneratiewe longsiekte
  • Pulmonale embolisme
  • GERS
  • Geïrriteerde lugweë

5
Snellerfaktore van Asma
  • Infeksies - veral viraal
  • Allergene - Huisstofmiet, swamme, Katepiteel,
    Honde epiteel, grasse
  • Sigaretrook
  • Koue lug
  • Industriële irritante
  • Spanning

6
Patologie van Asma
7
Patologie van Asma
8
Patologie van Asma
9
Diagnose van asma
  • Kliniese geskiedenis soos definisie
  • Spirometrie Fev 1 minder as 80 van voorspelde
    waarde.
  • FEV1/VK minder as 65
  • gt 12 verbetering na toediening van kortwerkende
    beta stimulant.

10
Diagnose van asma
11
Hantering van Asma
  • Non farmakologies
  • farmakologies

12
Nonfarmakologies - Verminder allergeen
blootstelling
  • ventilasie van geboue
  • Ioniseerders
  • verhoed verkoue, griep, BLWI
  • Spartaanse meubels
  • Matrasse in die son
  • Bad Kat elke week

13
Middels vir asma
  • Aminofillien
  • Oraal en intraveneus
  • Beta stimulante
  • Oraal, intraveneus, inhalasies, nebulisasies
  • kortwerkend, langwerkend
  • Steroïede
  • Intraveneus, oraal, inhalasies, nebulisasies
  • Leukotrien antagoniste

14
Aminofillien
  • Swak brongodilatories - hoë dossise nodig
  • Laer dosis wel anti-inflammatories
  • Goedkoop
  • Geneesmiddel interaksies
  • Meer newe effekte as ander orale meds

15
Beta stimulante
16
Beta stimulante (agoniste)
  • Effektief net voor oefening en blootstelling van
    bekende sneller
  • Toleransie kan ontwikkel
  • Geen effek op inflammatoriese kaskade
  • Langtermyn beta stimulante potensieer Steroïede

17
Langwerkende beta agoniste
  • Facet studie - formoterol het n sinergistiese
    effek saam met steroiede

18
Mean change in morning PEF from baseline
40
30
BUD800F
20
BUD200F
Mean change in PEF (litres/minute)
10
BUD800
0
BUD200
-10
-20
-10
10
1 3
6
9
12
0
Run-in (days)
Treatment (days)
Treatment (months)
Study period
19
FEV1 as of predicted
95
BUD200
BUD200F
BUD800
BUD800F
90
85
FEV1 ( of predicted)
80
75
70
-1
0
1
2
3
6
9
12
Time (months)
20
Verklaring vir sinergisme (Peter Barnes)
21
Steroïede
  • Inhalasie steroïede die mees potente
    anti-inflammatoriese middel.
  • Inhibeer Eosinofiele, limfosiete, mastselle.
  • Mees koste effektiewe wyse om asma te
    kontrolleer.
  • Dosis respons neem dramaties af bokant 800 µg/d
    met toename in newe effekte

22
Limitations Associated with Increasing the Dose
of Inhaled Corticosteroids
Therapeutic effect Systemic activity
  • Increasing the dose may not enhance clinical
    effectiveness
  • Higher doses do increase local and systemic
    effects
  • Guidelines recommend the use of the lowest
    possible dose that controls disease in order to
    limit side effects

Response
0 50 100 200 400 800 1600
Dose (µg)
Adapted from Global Initiative for Asthma (GINA)
Pocket Guide for Asthma Management and
Prevention, National Institutes of Health
Publication No. 95-3659B, Bethesda, MD, 1998
Lipworth BJ, Wilson AM Semin Respir Crit Care
Med 199819(6)625-646 Bisgaard H Pediatr
Pulmonol 1997Suppl 1527-33.
23
Steroïede
  • Begin met hoë dosis vir 4 tot 8 weke en verminder
    dan na 800 of minder
  • Hoë dossise geassosieer met subkapsulêre
    katarakte en verhoogde oogdrukke
  • Verminder Moniliase met spasieerder.
  • Vroeë intervensie met steroïede en voldoende
    gebruik voorkom hermodulering en brongeale
    fibrose.

24
Steroïede
25
Eikosanoïed metabolisme
Sisteniel leukotriene
LTC4 LTD4 LTE4
26
Sisteiniel Leukotriene
Steroïede nie effektief hierteen nie
27
Sisteiniel Leukotriene
28
Cysteinyl Leukotrienes Are Important
Pro-Inflammatory Mediators in Asthma
Decreased mucous transport
Cationic proteins (epithelial cell damage)
Increased mucous secretion
Airway epithelium
Increased release of tachykinins
Sensory C fibers
Eosinophil recruitment
Blood vessel
Smooth muscle
Edema
Inflammatory cells (e.g., mast cells, eosinophils)
Contraction and proliferation
Adapted from Hay DWP et al Trends Pharmacol Sci
199516304-309.
29
Montelukast as Additive Therapy to Inhaled
Beclomethasone in Chronic Asthma FEV1 and
Asthma Symptom Scores
Beclomethasone 200 µg twice daily (n200)
Montelukast 10 mg once daily beclomethasone
200 µg twice daily (n193)
Asthma Symptom Scores
FEV1
0.15 0.1 0.05 0 0.05
0.14
0 0.05 0.1 0.15
Meanchange insymptomscore
0.02
Meanchangein FEV1(L)
0.13
0.02
plt0.001
p0.041
Adapted from LaViolette M et al Am J Respir Crit
Care Med 19991601862-1868.
30
Montelukast as Additive Therapy to Inhaled
Beclomethasone in Chronic Asthma Asthma
Exacerbations and Attacks
Beclomethasone 200 µg twice daily
(n200)Montelukast 10 mg once daily
beclomethasone 200 µg twice daily (n193)
Asthma Exacerbation Days
Asthma Attacks
20 15 10 5 0
14 12 10 8 6 4 2 0
25
17.92
12
48
13.37
Least- squaremean of days
Least- square mean of days
6.2
p0.041
p0.055
Adapted from LaViolette M et al Am J Respir Crit
Care Med 19991601862-1868.
31
Leukotrien antagoniste
  • Montelukast (10 mg/d) en Zafirlukast (20 mg
    bd)
  • Respons toon variasie agv genetiese variasie in
    5-lipooksigenase
  • Additiewe effek saam met Steroïed inhalasies
  • Montelukast vanaf 6 jaar geregistreer (5 mg/d)

32
Leukotrien antagoniste
  • Werk binne die eerste 24 uur.
  • Montelukast inhibeer nie Sitochroom P450 nie
  • Newe effekte vergelykbaar met placebo
  • Aangedui as tweede linie terapie
  • Vervang nie inhalasie steroïede nie.
  • Kan Churg Strauss sindroom ontlok

33
Leukotrien antagoniste
  • Effektief by aspirien allergie
  • Effektief by oefenings geïnduseerde asma
  • Effektief by hooikoors
  • Moontlik ook vir urtikaria en ekseem.

34
Increasing Severity
Mild Intermittent
Severe
HIT EARLY, HIT HARD - THEN STEP DOWN
Inhaled Corticosteroid gt1000 µg/day /- Oral
Corticosteroid /- Long-acting ß2 agonist
/- SR theophylline
Inhaled Corticosteroids 500-1000
µg/day plus Long-acting ß2 agonist (preferred)
and / or SR theophylline
Inhaled Corticosteroid 200-500µg/day plus Lon
g-acting ß2 agonist (preferred) or SR
theophylline or Inhaled corticosteroid 500-1000
µg/day
Inhaled Corticosteroid 200-500µg/day (BDP
equivalent)
Refer pulmonologist
ß2 agonist prn May be required 4-6 times/day
ß2 agonist prn
ß2 agonist prn
ß2 agonist prn
ß2 agonist prn
35
Trapmodel benadering tot ASMA
  • Stap 1 Intermitterend Sporadies, lig
  • Stap 2 Gereelde aanvalle
  • Stap 3 Daagliks
  • Stap 4 Betekenisvol
  • Stap 5 Steroïed afhanklik.

NAEP
36
Trapmodel benadering tot ASMA
  • Stap 1 Intermitterend Sporadies, lig

37
Trapmodel benadering tot ASMA
  • Stap 1 Intermitterend Sporadies, lig
  • Stap 2 Gereelde aanvalle

38
Trapmodel benadering tot ASMA
  • Stap 1 Intermitterend Sporadies, lig
  • Stap 2 Gereelde aanvalle
  • Stap 3 Daagliks

39
Trapmodel benadering tot ASMA
  • Stap 1 Intermitterend Sporadies, lig
  • Stap 2 Gereelde aanvalle
  • Stap 3 Daagliks
  • Stap 4 Betekenisvol

40
Trapmodel benadering tot ASMA
  • Stap 1 Intermitterend Sporadies, lig
  • Stap 2 Gereelde aanvalle
  • Stap 3 Daagliks
  • Stap 4 Betekenisvol
  • Stap 5 Steroïed afhanklik.

41
(No Transcript)
Write a Comment
User Comments (0)
About PowerShow.com